Tao Yongqiong, Zhou Yonghong, Li Wenqing, Ding Yitong, Wu Peng, Wu Zhouquan, Shi Haifeng
Department of Radiology, The Third Affiliated Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, China.
Department of Anesthesiology, The Third Affiliated Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, China.
Sleep Med. 2025 Jul;131:106482. doi: 10.1016/j.sleep.2025.106482. Epub 2025 Mar 28.
This study aims to evaluate functional changes in the default mode network (DMN) and glymphatic system in individuals of chronic insomnia disorder (CID) with comorbid major depression disorder (MDD).
A total of 112 CID patients and 56 healthy controls with good sleep (GS) were enrolled. CID patients were divided into were further divided into a CID-only group and a group with CID and comorbid MDD. Resting-state functional magnetic resonance imaging (rs-fMRI) assessed DMN dysfunction and its connectivity with external networks. To determine whether comorbid MDD exacerbated the decline in glymphatic function in patients with CID, the diffusion tensor imaging along the perivascular space (DTI-ALPS) index was calculated. Binary logistic regression identified key imaging features for diagnostic modeling.
Patients with CID and comorbid MDD exhibited significantly weakened functional connectivity within the DMN. In contrast, the key node posterior cingulate cortex(PCC) of the default mode network showed enhanced functional connectivity with brain regions outside the DMN, including middle cingulate cortex and supplementary motor area. Regarding the glymphatic system, the lower ALPS index in CID patients with comorbid MDD was lower than in CID patients, indicating reduced glymphatic function compared to those without depression. HAMD scores were significantly associated with bilateral Dyproj values (P < 0.001) and the functional connectivity values of PCC_L-SMA_L and TempP_L-PHC_L (P < 0.01). The diagnostic model developed based on these findings demonstrated high diagnostic efficacy for CID with comorbid MDD.
The destabilization of subsystems within the DMN may represent the neurological mechanism through which depression contributes to insomnia. Comorbid depressive disorders may exacerbate glymphatic dysfunction in patients with CID, highlighting the importance of early clinical intervention for depressive symptoms in insomnia disorder.
本研究旨在评估合并重度抑郁症（MDD）的慢性失眠障碍（CID）患者默认模式网络（DMN）和类淋巴系统的功能变化。
共纳入112例CID患者和56例睡眠良好的健康对照者（GS）。CID患者进一步分为单纯CID组和合并CID与MDD组。静息态功能磁共振成像（rs-fMRI）评估DMN功能障碍及其与外部网络的连接性。为确定合并MDD是否会加剧CID患者类淋巴功能的下降，计算了沿血管周围间隙的扩散张量成像（DTI-ALPS）指数。二元逻辑回归确定了诊断建模的关键影像特征。
合并CID与MDD的患者DMN内功能连接显著减弱。相比之下，默认模式网络的关键节点后扣带回皮质（PCC）与DMN外脑区，包括中扣带回皮质和辅助运动区的功能连接增强。关于类淋巴系统，合并MDD的CID患者的ALPS指数低于CID患者，表明与无抑郁症患者相比类淋巴功能降低。汉密尔顿抑郁量表（HAMD）评分与双侧Dyproj值（P < 0.001）以及PCC_L-SMA_L和TempP_L-PHC_L的功能连接值显著相关（P < 0.01）。基于这些发现建立的诊断模型对合并MDD的CID具有较高的诊断效能。
DMN内子系统的不稳定可能代表了抑郁症导致失眠的神经机制。合并的抑郁症可能会加剧CID患者的类淋巴功能障碍，突出了对失眠障碍患者抑郁症状进行早期临床干预的重要性。
